District 51 clinic cuts employee health costs
School District 51’s health insurance system was ailing.
The number of claims costing the self-insured district $25,000 or more grew from 62 in 2007-08 to 71 in 2009-10. The cost of paying those claims jumped from $3.8 million to $5 million over the same period.
The district bumped deductibles for employees and their families from $2,500 per person to $4,000 in 2009 to help cover larger claims. Deductibles stretched again to $5,950 in fall 2010.
With more money to pay out of pocket, those insured by the district began visiting their primary care doctors for basic and preventative care less often. Physician office visits among people insured by the district dropped 31 percent year-over-year in 2010-11. Again that year, claims of $25,000 or more stuck at 71 and the cost of covering those claims jumped to $7.16 million.
There was no obvious cure for the vicious circle. But the district hoped to at least treat the problem with the concept of an employee clinic. They requested proposals from four companies and chose to form a partnership with Community Hospital 13 months ago today. Community Hospital President and Chief Executive Officer Chris Thomas said the partnership contract is designed to get more district employees to seek preventative care from primary care physicians.
“I’ve always said the most cost-effective place to receive health care is in a primary care doctor’s office,” Thomas said.
Through the clinic system, District 51 employees insured through the district and their insured family members can get basic care and lab work like a physical or strep test for free through a Community Hospital-affiliated physician at Grand Valley Primary Care, 603 28 1/4 Road. If they need non-emergency care and the Primary Care office is closed, patients can visit Grand Valley Urgent Care — or the Community Hospital emergency room if Urgent Care is closed — for a $25 co-pay. The clinic contract also provides 55 commonly prescribed medications for free through Orchard Pharmacy, and clinic participants can get free health coaching through the hospital.
Although the first year of a two-year contract with Community Hospital cost the district $375,796, the goal of the clinic is to save the district money by encouraging employees to take better care of their health. The hope is free or low-cost care not subject to an employee’s high deductible will reduce catastrophic claims through early detection and treatment of potentially serious illnesses.
It’s hard to say how many heart attacks have been prevented by the clinic system, District 51 Risk Manager Sheila Naski said. But she said it’s “common sense” that the system is helping.
“If a disease is caught in the early stages, it’s going to cost less than a diabetic coma or chemotherapy for stage three cancer,” she said.
So far nearly 60 percent of the 2,613 people insured by the district, 1,556, have participated in the clinic since it launched March 1, 2012. Naski said the clinic gives the majority of insured employees who will never reach their $5,950 deductible a reason to keep their insurance. It also gives the district hope of making its insurance program solvent. The district insurance fund borrowed $1.5 million from the general fund a couple of years ago to cover big claims but was able to pay back half of that amount this year. The other half is expected to be repaid in 2014.
So far, Naski is happy with changes in the insurance program since the clinic opened. Primary care office visits didn’t go up but didn’t go down much either, staying steady between 2010-11 and 2011-12. Office visits are on track to be steady again in 2012-13.
The cost and number of large claims dipped in 2011-12, even though the clinic was not open for all of that year. Lower claims costs may correlate to the district doubling participation year-over-year in a health risk blood screening in fall 2012. Among 1,480 participants, 45 percent were told they had an abnormal or critical result, such as diabetes, high cholesterol, high blood pressure or a higher risk for cancer.
Community Hospital staff called each of the people with an abnormal result and offered all of them one-on-one health coaching. The most common findings were a need for more fitness (61 percent), a need to lose weight (58 percent), and an elevated cancer risk (49 percent).
Naski said without the clinic, it’s hard to tell how many people would have lived without knowing about or treating a health condition.
“Now not only do they know they have a health problem, they have a coach to go to,” Naski said.
Thomas said the clinic is a “win-win” for the district and the hospital because the hospital can offer services at a discount to the district because the services are offered in bulk. Plus, the hospital’s doctors have more utilization. Many of the nearly 1,600 clinic patients were new to Grand Valley Primary Care, he said.
District employees can still see their regular primary care doctors, but those visits may be subject to a deductible.
Thomas said the hospital is bringing on three more physicians this fall to help handle the load of clinic patients and he hopes the contract is continued a year from now. Both Thomas and Naski agree the next step for the clinic is to help people manage the conditions they’ve been made aware of through check-ups and the health risk assessment. More access to diabetes education, weight-loss contests and incentives for participating in health screenings are possible. The district already offered a $50 gift card and a 20 percent reduction of deductibles for this year’s health risk screening participants and will likely offer similar benefits this fall, although the deductible reduction will likely come with a caveat, Naski said: Those who had a health issue identified will have to improve their baseline health risk factors to earn the discount.